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Catheter Exit-Site Infection — SCE Infectious Diseases MCQ

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HardHealthcare-Associated InfectionsCatheter Exit-Site InfectionSCE Infectious Diseases

Purulence and erythema are confined to a tunnelled-catheter exit site. Blood cultures are negative, there is no tunnel tenderness and the patient is stable. What is the most proportionate initial plan?

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Correct answer: B — Obtain a swab, give organism-directed local/systemic treatment and retain the line with close reassessment unless infection progresses after review

The best answer is “Obtain a swab, give organism-directed local/systemic treatment and retain the line with close reassessment unless infection progresses after review”. Exit-site infection without bacteraemia or tunnel involvement may be treated with the catheter retained, but progression or non-response changes the source-control decision. “Remove every catheter before obtaining cultures” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Give 6 weeks of intravenous vancomycin despite no bacteraemia” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use chlorhexidine alone despite purulent infection” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Ignore the finding because exit-site pus is expected” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: NICE CG139 healthcare-associated infection recommendations: https://www.nice.org.uk/guidance/cg139/chapter/Recommendations